When the Regulator Believes in Fairies, Who Protects the Public?

It would appear to be a common mistake in the regulation of alternative medicine to assume that those trained in the subject, and who practice it, can be considered experts in the subject. And that those experts can help formulate good regulatory practices.

The nature of expertise has plagued philosophers since the time of Plato, whose Socratic dialogues explored how you could tell a doctor from a quack. Plato struggled with a solution and concluded that being wise was not enough; you also needed to be a physician to spot another true physician.

This is a rather unsatisfactory conclusion, as it leaves non-physicians unable to recognise expertise, and so liable to exploitation by quacks. Pragmatic solutions to this problem are central to many of the themes of this blog. However, without diving into an full examination of the tricky philosophical nature of recognising expertise, let us take the view that expertise involves holding a substantial body of true beliefs about a domain of knowledge and that the weight of their true beliefs is greater than their false beliefs.

From this perspective, we can see that people who believe in and practice homeopathy, chiropractic, herbalism and acupuncture cannot be considered experts since the major beliefs in these systems can quite easily be shown to false. If you believe that homeopathic sugar pills can have specific therapeutic effects then you simply cannot be considered an expert in such matters as this is straightforwardly untrue. If you believe that illness is caused by chiropractic subluxations in the spine then your expertise must be in question as there is no good evidence to suggest this is correct. If you believe that individualised concoctions of herbs can treat specific illness then your beliefs are contradicted by the evidence base.

This point appears to go over the head of various regulators in the UK.

In the past few weeks we have seen that the General Pharmaceutical Council dropped cases against pharmacists that were caught in a 2006 BBC Newsnight sting selling sugar pills as protection against malaria to a student going to Africa. The actions of these pharmacists quite simply would put the lives of people at risk of dying through their beliefs in the magic of homeopathy. The GPhC says that the pharmacists concerned had given reassurances that “remedial action” had been taken to prevent the situation happening again. To their embarrassment, the BBC repeated the sting the same week and found homeopathy-believing pharmacists dishing out sugar pills to prevent malaria again. It is likely that this four year investigation will re-open to the shame of the pharmacists’ regulator.

The reasons why the cases were dropped do not hold water. What influence other homeopaths had is not known. But it is worth noting that a previous president of the Royal Pharmaceutical Society, the immediate forerunner of the recently reorganised regulator, was Christine Glover, who has now retired to run her homeopathic pharmacy. That a homeopath can have held such prominent positions in an organisation charged with protecting the public from unsafe practices is extraordinary.

The General Chiropractic Council are also going through regulatory tortures of their own making. After the British Chiropractic Association unsuccessfully tried to sue science writer Simon Singh for pointing out in the Guardian that their claims that magically cracking spines could cure childhood conditions such as colic and asthma, hundreds of complaints were made to the regulator about chiropractors making similar claims.

How could the regulator then find their members guilty of making misleading claims when the regulator had given the green light to such claims?

The problem is for the regulator is that they themselves had issued leaflets saying that chiropractic could treat such conditions, no doubt on the advice of chiropractors on various committees within the regulator. How could the regulator then find their members guilty of making misleading claims when the regulator had given the green light to such claims? As such, the adjudications on the first cases heard appear to be more about saving the face of the regulator than protecting the public from chiropractors with deluded beliefs.

Within government, including those with pseudoscientific beliefs in positions where expertise is vital is not restricted to regulatory bodies. When formulating policy on drugs, ministers are obligated to take into account the views of a statutory advisory body. Professor David Nutt, chairman of the Advisory Council on the Misuse of Drugs, gave a lecture on how the harms to society from young people riding horses as a hobby were similar to the harms caused by taking the drug ecstasy. Both present risks to people engaging in these activities. As a result, Nutt was sacked by the Home Secretary. Several other members of the advisory committee resigned in protest of the sacking of an independent scientific advisor for merely expressing an opinion about evidence of harms.

We have a new government now and new appointments have been made. The first is an expert in needles. Unfortunately, not the sort of needles that drug users use, but acupuncture needles. One has to wonder how someone who might believe that inserting needles in people can unblock ‘chi’ within ‘meridians’ and cure various conditions could have a robust approach to evidence, however, fortunately, Sarah Graham appears to have some reasonable views on young people and drugs.

The same cannot be said for another appointment. GP, Dr Hans-Christian Raabe, is a member of the bizarre political party, the Christian Party which has a “zero tolerance” policy towards drug use. He is also a member of the Maranatha Community, a Christian lobbying group that has written several papers trying to change government policy on drug law. Last night I tweeted some quotes from Raabe on his views on drugs:

Lack of religious commitment is a risk factor for drug abuse.

Harm-reduction actually encourages rather than prevents drug misuse.

Spiritual/religious involvement predicts fewer problems with alcohol.

Religious resources may serve as a potentially important ally in promoting health.

Need to look at the impact of interventions to strengthen the two-parent family

Too much attention has been given to the militant lobby groups which urge the legalisation of drugs or the adoption of ‘harm reduction’.

Most worryingly is Raabe’s belief that a strategy of looking at the relative harms of various drugs and so devising strategies to minimise harm from them is counterproductive. Raabe’s faith-based conviction is that drugs are inherently wrong and so any policy that might overlook less harmful activities is wrong. When David Nutt was sacked for expressing views on relative harm, we were angry that government was ignoring the advice of its advisors. Now we find ourselves hoping they do.

When David Nutt was sacked for expressing views on relative harm, we were angry that government was ignoring the advice of its advisors. Now we find ourselves hoping they do.

The MHRA is the government body charged with protecting the public from medical drugs and devices that are unsafe or do not work as described. Through loopholes in legislation, homeopathic medicines can be given a license without providing evidence of efficacy. Instead, absurd accounts of homeopathic rituals called ‘provings’ can be used to justify claims.

At the moment the MHRA are evaluating license applications for a number of products including a sugar pill that is labelled that it can treat nicotine withdrawal, and another sugar pill claiming to treat flu-like symptoms. From the outset we can be quite certain that the pills contain no active ingredient (such is the nature of homeopathic ultra-dilution) and that they cannot achieve the claims made of them. However, the brief minutes show that various experts are evaluating these claims and considering awarding a license.

Amongst these experts is homeopath Mr David Needleman BScPharm MRPharmS LCH MARH RHom FBIH. Needleman is a founder of the splinter homeopathic group, the Alliance of Registered Homeopaths. He has set up a homeopathic telephone helpline for ‘acute conditions’ that tells callers, after a consultation for £1.50 per minute, what the label on the sugar pills prescribed ought to say.

The Alliance is a strange organisation that broke away from the Society of Homeopaths because it wanted its members to practice how they best feel without interference. You can appreciate the extreme emerging views of such a group by visiting the web site of Needleman’s co-Director, Steve Scrutton, as he rants barely coherently about the ‘evils’ of modern medicine, vaccines and the money grabbing ways of doctors. His advice on everything from cancer to vaccine avoidance can at best be describes as thoroughly irresponsible.

Even stranger is another advisor on the MHRA committee. Dr Micahel Evans is a GP who is one of the UK’s most prominent advocates of anthroposophical medicine. This is a belief system first advocated by mystic Rudolf Steiner. Advocates of anthroposophical medicine have to first train in mainstream techniques but then their training is ‘enhanced’ by Steinerist beliefs in “spiritual science” where science is supposedly extended by belief in the ‘life element’ and mystical ways of knowing the truth. Dr Evans will not just treat the material body, but will also take into account the ego, astral and etheric realms of being. Steinerism infiltrates many aspects of life including the rather disturbing Steiner Waldorf schools that operate with some shocking beliefs that they would rather you did not know about, as has been explored in depth on the dcscience blog.

Whilst using conventional medical techniques, anthroposophists use their spiritual beliefs to wedge in various forms of pseudo-medicinal techniques such as their versions of homeopathy, herbalism and hydrotherapy. In his book, he tells us such things as “HIV destroys the bodies ability to be a suitable vehicle for the ego, or spirit”. On treatments, his passage on treating a female with depression, shows the nature of anthroposophical thinking,

The kidney’s association with the astral body makes it come to mind when a patient presents severe symptoms of anxiety and agitation. … With the kidney specifically in mind, copper ointment was applied over the kidney region and a homeopathic preparation of naturally occurring copper oxide, Curpite D6, was given orally. She also had mustard footbaths… Her depression was treated with a liver medicine, Stannum per Taraxicum (tin potentised using dandelion.)

As well as the homeopathy advisory board, Evans also sits on the Herbal Medicines Advisory Committee. Quite what influence Needleman and Evans have over the decision making process within the MHRA is difficult to ascertain. The MHRA say in their minutes of the meeting that information discussed will be withheld under Section 43 of the Freedom of Information Act 2000.

The MHRA weighs the commercial interests of those wishing to profit from blatantly misleading medical claims over the public right to know how it is being protected.

Section 43 is designed to protect trade secrets and commercial interests. It would appear that the MHRA weighs the commercial interests of those wishing to profit from blatantly misleading medical claims over the public right to know how it is being protected.

I could go on. The last government saw fit to bring in a form of self-regulation for a rag-bag of alternative medicines in the form of the Complementary and Natural Health Care Council. Its basic idea was that the public could be protected if Ofquack, as it has become known, could validate that practitioners had been ‘properly trained’ in their techniques. Complaints about misleading claims have been met with absurd judgements where the regulator recognises the claims are untrue but were made because that is how the practitioners were trained. Hence, “fitness to practice was not impaired”.

At the heart of the problem is the various authorities inability to make judgements on what is science and what is pseudoscience. Indeed it has recently said that “The government does not find it helpful to define pseudoscience”. Admittedly, there are indeed difficulties about drawing sharp ontological boundaries around science and pseudoscience. However that does not mean that such categories do not exist. Just as it is not possible to categorise all times of the day into day and night does not mean day and night do not exist and that it is not helpful to draw a distinction.

Homeopathy is classic pseudoscience. As are most forms of alternative medicine. Being cowardly in saying so risks peoples health, defrauds them by allowing government endorsement of useless products and undermines our regulators abilities to carry out their duties to protect the public.

Recognising that training is not the same as expertise would be a good first step. Real expertise comes from critical thinking and having an ability to understand the limitations of personal knowledge. Those are attributes that are nearly non-existent amongst practitioners of the pseudo-medical cults.

Been reading your blog for many months now and you seem to leave psychological medicine alone but within the NHS at the moment there is a lot of weirdness being foisted on patients. Not only including so called psychodynamic therapy (witchcraft) I have also come across therapists using whacko NLP and the cringeworthy Eye Movement Desentisation and Reprocessing therapy. Come on Andy, take a pop at psychology for a change.

Herewith my comments in relation to this public consultation document:

Review of Medicines Act 1968: Informal consultation on issues relating to the product licences of right (PLR) regime and homeopathy

The principles here should be on the one hand public safety and on the other preserving a free society.

People should be free to do whatever they wish within the law and an over-regulated society stifles debate and innovation. On the other hand the government has a duty to protect the public.

The danger in this case is that regulation of any medicine that does not pass the rigorous safety and efficacy procedures required of conventional medicines may give the false impression that the regulatory body approves the medicine in question.

I would suggest that a medicine that does not pass conventional screening procedures should not be licenced at all as a medicine and that it should be illegal to advertise or promote it as such. However that should not prevent the sale of a product provided (1) it was not actually dangerous and (2) that no misleading claims were made for it.

It is sometimes claimed that homeopathic remedies have no ill-effects. Clearly, though, if someone takes a homeopathic product in place of a properly licenced medication (for example for malaria prophylaxis) then serious harm and even death may result due to taking false reassurance from the fact that the medication has some kind of licence from an official body.

In respect of paragraphs 23 and 25 of the consultation document:

Para. 23: “…the MHRA is reviewing product labelling requirements and elements of the guidance to ensure there is greater clarity on the position concerning efficacy as accepted within homeopathic practice.”

Para. 25: “A homeopathic medicinal product licensed only on the basis of safety, quality and use within the homeopathic tradition”

In para.23 the word ‘efficacy’ is out of place, since there is no convincing evidence for the efficacy of homeopathic products. ‘Efficacy as accepted within homeopathic practice’ is misleading and will be misunderstood. The wording should clearly state that the product does not pass the safety and efficacy criteria required of a licenced medicine and is not a licenced medicine.

In para.25 the word ‘quality’ is virtually without meaning in this context unless defined. Once again I would question any suggestion that such products be labelled as ‘licenced’ or indeed ‘medicinal.’

The public would then be protected by other existing legislation and of course caveat emptor.

Whilst I support and welcome the probing, questioning and challenging stance of the Quackometer it does suffer from time to time, well actually most of the time, from its inherent perspective of dismissing everything that doesn’t happen to agree with its rigid and self serving stance. General acceptance of ‘Le Canard’ as serious comment would most certainly benefit from a more open analysis of things it wishes to eventually denigrate. None more so than when a view or person is dismissed and ridiculed from a position of seemingly complete ignorance.

Your example in this missive is the way you attempt to portray Dr Raabe as if he were an oddball. You begin with an unfounded assertion that somehow he shouldn’t be an able and appropriate person to express his views to government. Your description of the Christian Party as ‘bizarre’ is, in itself, very weird and undermines any semblance of an independent critique. There is nothing bizarre or even unusual about religious organisations forming political groups. One just needs to consider the inherently establishment role of the Church or England or the many theocracies around the world. If you hadn’t noticed, religion is very much a part of politics almost everywhere. As for Christianity, my guess is that it’s pretty well established now.

The article then goes on to paraphrase a number of ‘views’ of the Christian Party as if they were so ridiculous as to not be worth consideration when, in fact, there is ample evidence to the contrary.

It is well known that religious and/or spiritual awareness can promote dramatic behavioural changes particularly with drug and alcohol addiction and as such is a cornerstone of conventional alcohol abuse treatment. As for harm reduction, its influence on behaviour is actually self-evident. Clearly if a message is presented that says it’s ok to indulge in a particular behaviour then it is more likely that more people will do that. It is a reasonable position to take to assert that the argument for ‘legalisation’ or the promotion of drugs by any other means gets much more exposure than it deserves and considerably more than the opposing and quite sensible view.

Even supporters of such moves acknowledge that harm reduction strategies, including ‘legalisation’ will inexorably lead to far greater usage. This absolutely certain outcome, however, is misleadingly downplayed whenever support of such an approach is presented.

Ironically, therefore, your attempted discrediting of Dr Raabe rather backfires. If you want to oppose the arguments it might be better, ‘in your own words’ to supply some evidence rather than relying on insinuation alone.

Regarding the “inexorable” issue of harm reduction policies “lead(ing) to far greater usage”, the evidence base for such a claim is thin indeed.
In several cases, such policies lead to a reduced incidence of use for the drug in question, when handled appropriately.
An example would be the “medicalisation” of heroin use in Zurich, Switzerland, which, while certainly not the paradigm altering event the press claimed at the time, did lead to a reduced take up of heroin use.
On many medical issues the British government seems clueless, and on drug use more than most, as Le Canard pointed out, they proceeded to fire their most senior advisor when his findings lacked the appropriate political message.
Incidentally, the issue at hand here is not people of religious faith in positions of advisory responsibility, but such people making their decisions and advising on the basis of that faith, rather than the evidence.
THAT is frightening…

In fact, I think my views are perfectly justified given that he is not only the only overtly political advisor on the committee, but that his politics are overtly theocratic and offensive to many groups of people. That other countries politics are dominated by theocratic parties does not mean the British, mostly secular approach to politics, should embrace overtly religious parties.

And I do not know if people with ‘spiritual awareness’ have fewer drug/alcohol problems. And it is rather immaterial, because even if this is true that does not mean that effective approaches to drug problems should be ‘faith-based’. It is not a two way street here. What would you propose to do with drug users who do not believe in fairies?

Drug harm reduction strategies do not say ” it’s ok to indulge in a particular behaviour”. It is all about fair appraisal of risks and allocation of resources to high risk areas where most harm is being done. Raabe (and you) misrepresent that stance.

I would also argue that it is completely false to say that the “argument for legalisation” gets much more exposure. The whole rhetoric of the past decades has been on the ‘war on drugs’ and ‘just say no’ type approaches. This has demonstrably failed to achieve any of its goals. It is no wonder that more people are looking at alternatives to this approach. If decriminalisation voices are now gaining in exposure it is because such policies need active exploration to their merits, not knee-jerk condemnations.

I would also challenge to you explain why if harm reduction strategies actually reduce harm to people, but as a consequence (if it is true) that some times of drug usage go up, why that is an inherently bad thing? What are you goals? To reduce harm, or for people not to take drugs?

Something that looks like or claims to be science but which continues to hold its claims as true after they have failed to be verified or been falsified by properly conducted investigations.
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And by the way (as a separate point), although I am not religious in the conventional sense I do think the dismissal of a possible connection between spirituality and alleviating substance abuse may be a little premature. It is an interesting subject and worthy of debate.

“(the quackometer’s) inherent perspective of dismissing everything that doesn’t happen to agree with its rigid and self serving stance. General acceptance of ‘Le Canard’ as serious comment would most certainly benefit from a more open analysis of things it wishes to eventually denigrate,”

just in case the rest of what you say is equally daft. Life’s too short.

I said the quote I selected was ‘daft’ not ungrammatical. I don’t see anything wrong with his grammar in the bit I read but the suggestion that Le Canard is ‘self-serving, dismisses what he doesn’t agree with or doesn’t analyse stuff’ is demonstrably untrue.

The learning point here is: if you want to make a serious point that people can be bothered to read, do it first and leave any snarky comments to the end.

For me, the founding principle of science is having a mind not clouded or warped by unfounded beliefs. This article raises many questions that should be debated as much as the current debates about the economy. Unfortunately, these issues seldom get a mention.

It is unfortunate, and I think also a sad reflection on the state of our society, that religion still has a huge influence on our politicians. We have an unelected House of Lords which has 26 bishops of the Church of England (see: http://www.crockford.org.uk/listing.asp?id=256). Why not have the cast of Peter Pan as Lords? It would make as much sense.

I’m not sure that using a ‘Grauniad’ article strengthens your position much particularly as it doesn’t put him into any particularly unusual category despite attempting to do so. Religious organisations do have strong opposing views to homosexuality so there is nothing bizarre in that. It may be your opinion that his politics are ‘overly theocratic’ but it certainly isn’t fact as written and the statement that they are offensive to many groups of people is quite meaningless unless you state which groups and how many people. After all you could mean three people you know at the golf club, two at the supermarket and your in-laws. Almost any view on any subject at all is likely to be offensive to someone yet that certainly isn’t a good argument for not presenting it.

The last sentence doesn’t make any sense to me because there is no restriction in English law on the establishment of political parties whatever daft (Monster Raving Loony Party) or moral basis they represent provided they remain within the law. Who the British (or English) people choose to support is up to them. My point about theocracies, that are also invariably dictatorships, wasn’t that it was something to be adopted but that politics and religion are inexorably mixed in England and many other parts of the world thereby underpinning my contrary view to your assertion that such an association is ‘bizarre’. It is by no means unusual to determine a political stance based upon faith. Whether you think that right or not is a quite different point.

There is significant and extensive evidence to show that people who, by whatever means, change their understanding from a parochial and materialistic view of life and their place in it to one that encompasses a spiritual dimension can and do make dramatic changes to their behavioural patterns. That being said spiritual awareness certainly isn’t the only way but for some it works.

Your employment of the term ‘fairies’ rather supports the point I made about the blog being self serving and quite biased. The term itself employs ridicule as a means of making a point but bizarrely and quite contrary to the oft lauded principles of fact, science and more fact you actually don’t know if there is a spiritual element to our being or not. Furthermore I have never met anyone yet who could define what, for them, might need to be seen, understood, or to manifest in order for such a concept to be accepted. Your position, therefore, is not dissimilar to one that might have defended the ‘flat earth’ principle in the face of new and not well understood knowledge.

If you don’t know perhaps a better position to take might be one of an open mind?

If you want to know what I would do with drug (specifically alcohol) users then read my book which will be published around the middle of the year. (The Sophisticated Alcoholic).

The problem I see with your perception of fair appraisal is that it misses most of the factors involved. The chemical effect is only one part of determining relative harm, but it isn’t the only one and I would argue not the most important. It’s well known that cocaine is less harmful than alcohol (from a chemical perspective) with the evidence currently available. That being the case it isn’t a good argument for making cocaine legal and more readily available.

Drug assessment includes social, economic, moral, ethical and cultural aspects so the conclusion of the chemist, however eminent, is just one factor.

There is probably some truth in your assertion that the historical approach has been less than successful. It’s hard to quantify because the pressures to ‘experiment’ have grown markedly and without the present stance more lives might be in danger. However, it is precisely because this is the current stance, the prevailing view, that any calls for liberalisation makes headlines. The size of them depends usually on a combination of the liberalisation message and who has promoted it. That being said it’s just what happens with a free, highly competitive and amoral press. Drug use is a problem and it will probably always be a problem but how much of one perhaps is the salient question?

In my view the argument for decriminalisation fails to make any substantive point other than, ‘if it isn’t illegal you cannot break the law’, and all proponents accept that a change to a legal and available status of a substance formerly restricted will result in significantly increased use. There seems to be little interest in ‘looking at alternatives’ as you so ‘neutrally’ put it. I’m only aware of the one item on the agenda, which is decriminalisation regardless of what other alternatives might be. Also this approach is a huge gamble. You know that where there is demand there is money to be made. It’s impossible to quantify the degree of expansion there might be with unfettered and heavily promoted drug use. We already have alcohol so how does it make sense to add more?

Harm reduction strategies are many and varied. They include concepts such as treatment rather than imprisonment, for example, and aren’t really the topic of the narrower points of declassification and decriminalisation. Simply put, if the restrictions are removed and availability increased more people will use and consequently more will be at risk. You might think that’s a good thing, but I’m not sure you’ll get much support.

It’s a couple of times now you have called me ‘self serving’ and I am not clear how you think stating my views here is supposed to serve any (non intellectual) interest of mine.

However, it now transpires that you are a NLP hypnotherapist who sells books and treatments involving past life regression, EMT, NLP and ‘spiritual’ approaches to alcohol and drug addiction. (Not to mention rather disturbing, and possibly illegal, hypnosis treatments for cancer.)

You would directly benefit from a more ‘spiritual’ approach from government to the problems of drug harms.

In what sense are your posts here less self-serving that mine?

I probably just ought to leave it there, but to cover some of your other points:

Whilst there are still many bigots out there who have problems with homosexuality, there is a pretty broad consensus from all main parties about ensuring rights for gays and lesbians. A party with an overtly bigoted stance is indeed quite bizarre if its members are included in mainstream political life.

I use the word ‘fairies’ because I see little difference between the big ones, that people believe, in with beards, halos and white robes that live in the clouds, and the little pretty ones with tiaras that live in bushes. I see no reason to be open minded about the existence of either.

Harm reduction here is not just about the direct chemical effects. It is about the total harm on both the individual and society as a whole. Part of that harm comes from the legislative structures that seeks to criminalise huge numbers of young people. I find that quite offensive. Decriminalisation is most definitely not about ‘if it isn’t illegal you cannot break the law’. It is about breaking the criminal, violent and destructive elements of allowing a supply chain to be in the control of thugs, and about forcing users into criminal lifestyles. These are not necessary consequences of drug use.

The debate continues to interesting but has “Who will “bell” the cat” quality about it.

Yes, homoeopathy (and other quackery) seems to enjoy a strange relationship with the regulating authorities, which somehow causes people who know better to pull their punches. Do they believe that the placebo benefits are sufficient for them not to bother too hard.
How do they answer the much more real issue of sugar/water remedies for travellers or indeed citizens of malaria infested countries?

So, how can this be addressed. Lots of wringing of hands here and on like-minded sites but what action can be taken? Can homoeopaths (and others) be taken to task, at law, for recommending sugar and/or water for malaria or HIV? Can the recommendations being made to tourists going to malaria infested countries be similarly sued/prosecuted?

I think that the gathering rejection of this witchcraft needs people taken to court, tested, found liable, (fined modestly, I’m not vindictive) and told, “Don’t do this silliness any-more”.

Without some serious defining moment we’ll still be looking at this nonsense for decades to come.

(Just a sort of PS: I understand that the EU is calling out that 80% of the claims of the products advertised as health inducing food, yoghurt-based, cranberries etc. don’t pass scrutiny. This means that the makers will have to tone down or amend advertising, ‘cos if they don’t the fines could be crippling. Could homoeopathy be put thru’ an EU wringer, too?)

Furthermore I have never met anyone yet who could define what, for them, might need to be seen, understood, or to manifest in order for such a concept to be accepted. Your position, therefore, is not dissimilar to one that might have defended the ‘flat earth’ principle in the face of new and not well understood knowledge.
– David Allen